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Siiba A, Kangmennaang J, Baatiema L, Luginaah I. The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review. PLoS One 2024; 19:e0297393. [PMID: 38394170 PMCID: PMC10889617 DOI: 10.1371/journal.pone.0297393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.
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Affiliation(s)
- Alhassan Siiba
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana Legon, Greater Accra Region, Ghana
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, Ontario, Canada
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2
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Shimizu K, Checchi F, Warsame A. Disparities in Health Financing Allocation among Infectious Diseases in Ebola Virus Disease (EVD)-Affected Countries, 2005–2017. Healthcare (Basel) 2022; 10:healthcare10020179. [PMID: 35206794 PMCID: PMC8872520 DOI: 10.3390/healthcare10020179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
The Ebola virus disease (EVD) outbreaks impacted the population health due to overstretched health systems and disrupted essential health services. Despite a call to achieve equal financial allocation depending on public health needs, there has been scant examination of the fairness of investment among infectious diseases. This study analyzes the extent to which equitable development assistance for health (DAH) has been provided in accordance with disease burden in EVD-affected countries. Estimates of disability-adjusted life years (DALYs) in the Global Burden of Disease (GBD) Study 2017 and DAH Database 1990–2019 in 2005–2017 were analyzed by disease category: vaccine-preventable diseases (VPDs), HIV/AIDS, malaria, tuberculosis, and EVD. HIV/AIDS generally recorded higher ratios of DAH per DALYs (DAH/DALYs). Malaria and tuberculosis showed different trends by country, and VPDs generally presented lower ratios. In West Africa in 2013–2016, DAH/DALYs surged in EVD and fluctuated in HIV/AIDS and malaria. Tuberculosis and VPDs consistently recorded lower ratios. To achieve the risk reduction during and after health emergencies, optimal funding allocation between diseases based on the disease burden is warranted in the pre-emergency period, along with measurement of immediate health needs of populations in real-time during an emergency.
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Affiliation(s)
- Kazuki Shimizu
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London WC2A 2AE, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.C.); (A.W.)
- Tokyo Foundation for Policy Research, Roppongi Grand Tower 34F, 3-2-1 Roppongi, Minato-ku, Tokyo 106-6234, Japan
- Correspondence:
| | - Francesco Checchi
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.C.); (A.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Abdihamid Warsame
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (F.C.); (A.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Arakelyan S, Jailobaeva K, Dakessian A, Diaconu K, Caperon L, Strang A, Bou-Orm IR, Witter S, Ager A. The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study. Soc Sci Med 2021; 291:114473. [PMID: 34662762 PMCID: PMC8689406 DOI: 10.1016/j.socscimed.2021.114473] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/01/2022]
Abstract
Non-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this cross-country multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n = 102) and Group Model Building workshops (n = 8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities' responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.
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Affiliation(s)
- Stella Arakelyan
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK.
| | - Kanykey Jailobaeva
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Arek Dakessian
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Karin Diaconu
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Lizzie Caperon
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Alison Strang
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Ibrahim R Bou-Orm
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Sophie Witter
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK
| | - Alastair Ager
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Queen Margaret University Way, Edinburgh, EH216UU, UK.
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Leone M, Ciccacci F, Orlando S, Petrolati S, Guidotti G, Majid NA, Tolno VT, Sagno J, Thole D, Corsi FM, Bartolo M, Marazzi MC. Pandemics and Burden of Stroke and Epilepsy in Sub-Saharan Africa: Experience from a Longstanding Health Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2766. [PMID: 33803352 PMCID: PMC7967260 DOI: 10.3390/ijerph18052766] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy-related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Massimo Leone
- The Foundation of the Carlo Besta IRCCS Neurologic Institute, 20133 Milan, Italy
| | - Fausto Ciccacci
- UniCamillus Saint Camillus International, University of Health Sciences, 00100 Rome, Italy;
| | | | - Sandro Petrolati
- San Camillo Hospital Department of Cardioscience, 00100 Rome, Italy;
| | - Giovanni Guidotti
- Azienda Sanitaria Locale (ASL) Roma 1 Regione Lazio, 00100 Rome, Italy;
| | | | - Victor Tamba Tolno
- Community of S. Egidio DREAM Program, Blantyre 312224, Malawi; (V.T.T.); (J.S.)
| | - JeanBaptiste Sagno
- Community of S. Egidio DREAM Program, Blantyre 312224, Malawi; (V.T.T.); (J.S.)
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Abdela SG, Berhanu AB, Ferede LM, van Griensven J. Essential Healthcare Services in the Face of COVID-19 Prevention: Experiences from a Referral Hospital in Ethiopia. Am J Trop Med Hyg 2020; 103:1198-1200. [PMID: 32762799 PMCID: PMC7470545 DOI: 10.4269/ajtmh.20-0464] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Globally, healthcare systems are facing the enormous challenge of the COVID-19 pandemic. Ethiopia is currently implementing different preventive measures to interrupt the transmission of SARS-CoV-2. The early effect of these preventive measures on essential healthcare service delivery is unknown. In this study, we looked at the number of essential healthcare visits over 8 weeks, 4 weeks before and 4 weeks after the implementation of preventive measures. During the implementation of these measures, patient flow decreased in all elements of essential healthcare service. The decline was dramatic for family planning (98%), emergency surgery (77%), and follow-up of chronic surgical conditions (70%). An understanding of the reasons behind the decrease in patient flow is urgently needed to design ways of sustaining essential care.
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Affiliation(s)
- Seid Getahun Abdela
- Department of Internal Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Odland ML, Bockarie T, Wurie H, Ansumana R, Lamin J, Nugent R, Bakolis I, Witham M, Davies J. Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey. BMJ Open 2020; 10:e038520. [PMID: 32907906 PMCID: PMC7482482 DOI: 10.1136/bmjopen-2020-038520] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Prevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions. METHODS This study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested ('screened'), knew of their condition ('diagnosed'), were on treatment ('treated') or were controlled to target ('controlled'). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded. RESULTS Of 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost. CONCLUSIONS In Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.
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Affiliation(s)
- Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Tahir Bockarie
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Bo, Sierra Leone
- School of Community Health Sciences, Njala University, Bo Campus, Bo, Sierra Leone
| | - Joseph Lamin
- Mercy Hospital Research Laboratory, Bo, Sierra Leone
| | | | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Miles Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Centre for Global Surgery, Department for Global Health, Stellenbosch University, Stellenbosch, South Africa
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Witter S, Zou G, Diaconu K, Senesi RGB, Idriss A, Walley J, Wurie HR. Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone. Confl Health 2020; 14:3. [PMID: 31921333 PMCID: PMC6945746 DOI: 10.1186/s13031-019-0248-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/24/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic. METHODS This paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO's health system assessment guide for NCDs. RESULTS We highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures. CONCLUSION Our study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings.
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Affiliation(s)
- Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Guanyang Zou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Reynold G. B. Senesi
- Directorate of Non-Communicable Diseases and Mental Health, Ministry of Health and Sanitation of Sierra Leone, Freetown, Sierra Leone
| | - Ayesha Idriss
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Haja Ramatulai Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Koroma IB, Javadi D, Hann K, Harries AD, Smart F, Samba T. Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak. F1000Res 2019; 8:795. [PMID: 31354948 PMCID: PMC6652098 DOI: 10.12688/f1000research.18563.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/05/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.
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Affiliation(s)
- Ibrahim Baimba Koroma
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Dena Javadi
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Smart
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Thomas Samba
- National Public Health Agency (NPHA), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
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Koroma IB, Javadi D, Hann K, Harries AD, Smart F, Samba T. Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak. F1000Res 2019; 8:795. [PMID: 31354948 PMCID: PMC6652098 DOI: 10.12688/f1000research.18563.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 01/28/2023] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.
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Affiliation(s)
- Ibrahim Baimba Koroma
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Dena Javadi
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Smart
- Directorate of Policy, Planning and Information (DPPI), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - Thomas Samba
- National Public Health Agency (NPHA), Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
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Decroo T, Fitzpatrick G, Amone J. What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover? Public Health Action 2017; 7:S1-S2. [PMID: 28744431 DOI: 10.5588/pha.17.0029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Tom Decroo
- Unit HIV & Infectious Diseases, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Jackson Amone
- Department of Clinical Services, Ministry of Health, Kampala, Uganda
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